Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
Epilepsy Behav. 2023 Nov;148:109471. doi: 10.1016/j.yebeh.2023.109471. Epub 2023 Oct 20.
The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) was recently introduced as a consensus-based, empirically-driven taxonomy of cognitive disorders in epilepsy and has been effectively applied to patients with temporal lobe epilepsy (TLE). The purpose of this study was to apply the IC-CoDE to patients with frontal lobe epilepsy (FLE) using national multicenter data.
Neuropsychological data of 455 patients with FLE aged 16 years or older were available across four US-based sites. First, we examined test-specific impairment rates across sites using two impairment thresholds (1.0 and 1.5 standard deviations below the normative mean). Following the proposed IC-CoDE guidelines, patterns of domain impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) to construct phenotypes. Impairment rates and distributions across phenotypes were then compared with those found in patients with TLE for which the IC-CoDE classification was initially validated.
The highest rates of impairment were found among tests of naming, verbal fluency, speeded sequencing and set-shifting, and complex figure copy. The following IC-CoDE phenotype distributions were observed using the two different threshold cutoffs: 23-40% cognitively intact, 24-29% single domain impairment, 13-20% bi-domain impairment, and 18-33% generalized impairment. Language was the most common single domain impairment (68% for both thresholds) followed by attention and processing speed (15-18%). Overall, patients with FLE reported higher rates of cognitive impairment compared with patients with TLE.
These results demonstrate the applicability of the IC-CoDE to epilepsy syndromes outside of TLE. Findings indicated generally stable and reproducible phenotypes across multiple epilepsy centers in the U.S. with diverse sample characteristics and varied neuropsychological test batteries. Findings also highlight opportunities for further refinement of the IC-CoDE guidelines as the application expands.
最近引入了国际癫痫认知障碍分类（IC-CoDE），作为一种基于共识和经验驱动的癫痫认知障碍分类法，已成功应用于颞叶癫痫（TLE）患者。本研究的目的是使用全国多中心数据将 IC-CoDE 应用于额叶癫痫（FLE）患者。
四个美国中心的 455 名年龄在 16 岁及以上的 FLE 患者的神经心理学数据可用。首先，我们使用两个损伤阈值（低于正常值均值 1.0 和 1.5 个标准差）在各个中心检查了特定测试的损伤率。根据五个认知领域（语言、记忆、执行功能、注意力/处理速度和视空间能力）中常用的测试，按照 IC-CoDE 指南确定了域损伤模式，以构建表型。然后，比较了这些表型的损伤率和分布与最初验证 IC-CoDE 分类的 TLE 患者的损伤率和分布。
在命名、语言流畅性、快速序列和转换以及复杂图形复制等测试中发现了最高的损伤率。使用两种不同的阈值截断，观察到以下 IC-CoDE 表型分布：23-40%认知完整，24-29%单一域损伤，13-20%双域损伤和 18-33%广泛损伤。语言是最常见的单一域损伤（两种阈值均为 68%），其次是注意力和处理速度（15-18%）。总的来说，FLE 患者报告的认知损伤率高于 TLE 患者。
这些结果表明，IC-CoDE 可应用于 TLE 以外的癫痫综合征。研究结果表明，在美国的多个癫痫中心，具有不同样本特征和不同神经心理学测试组合的情况下，存在稳定且可重复的表型。研究结果还强调了随着应用的扩展，IC-CoDE 指南进一步细化的机会。
